This research proposes to examine usual care practices for rural and urban children with attention deficit hyperactivity disorder (ADHD) in primary care settings, and to identify factors associated with collaborative approaches to care management. Specifically, this study seeks to understand the relationship between patterns of health care delivery (collaborative and non-collaborative care) and quality of care for children receiving treatment for ADHD. This application will also examine whether collaborative care between primary and specialty providers is associated with a greater likelihood of the patient receiving recommended care along accepted practice guidelines. There is empirical evidence based on adult populations to suggest that primary and mental health collaborative care models increased the percent of patients who received treatment at levels indicated by evidenced-based guidelines. There is, however, a gap between what research has shown to be effective for adults with psychiatric problems and what is practiced in the pediatric clinical setting. While effective treatments for children with ADHD have been developed and incorporated into accepted evidenced-based guidelines for primary care, information on care management approaches in rural delivery systems is scarce and there is no analysis of the prevalence of guideline-concordant treatment across collaborative and non-collaborative care management approaches in rural primary care settings. To investigate these critical issues, the proposed research involves collaboration with six Community Health Centers that are members of the Iowa/Nebraska Primary Care Association and has the following specific aims: 1. To examine whether rural children with ADHD as compared to urban children are more likely to be managed through non-collaborative rather than collaborative care approaches following diagnosis; 2. To examine variables which distinguish collaborative and non-collaborative approaches to care management for children with ADHD served in the primary care setting; and 3. To examine whether practice guidelines for the treatment of ADHD are more often recommended for children managed in collaborative versus non-collaborative models of management. [unreadable] [unreadable]